Peripherally inserted central catheters: a report of 2506 catheter days.

BACKGROUND: The establishment of reliable central venous access is essential in the management of patients with major complications, including pneumothorax and hemopneumothorax. Although peripherally inserted central catheters (PICCs) offer advantages over traditional central venous approaches, PICC lines are associated with a number of insertion and maintenance problems, including clotting and catheter fracture. These complications often result in catheter removal before completion of prescribed therapy.

METHODS: We conducted a retrospective descriptive study in a convenience sample of 322 consecutively placed PICC lines. Study variables included size of catheter, tip placement, infused solutions, patient diagnosis, and unit of line placement. The rationale for line discontinuance as well as for complication rates is described.

RESULTS: Complication rates for infection and central venous thrombosis were less than 1%. Phlebitis occurred in 9.7% of patients, and catheter fracture occurred in 9.7% of patients. Two distinct clusters of phlebitis, early and late development, were observed. Early phlebitis is attributable to the mechanics of insertion, and late phlebitis is attributable to chemical and patient-specific causes. Catheter fractures were primarily related to tearing of the catheter during insertion or traction on the catheter-hub junction (51.6%).

CONCLUSIONS: The majority of published data about PICC lines is in the area of chemotherapy or antibiotic infusion. Our study supports the use of PICC lines in patients receiving a variety of solutions, primarily parenteral nutrition. With an experienced, team approach to catheter placement and maintenance, PICC lines provide reliable, cost-effective venous access and reduce many of the complications of central venous access in a variety of clinical settings.